ImportanceAdverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes.ObjectiveTo examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race.Design, Setting, and ParticipantsThis cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024.ExposuresYearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health.Main Outcomes and MeasuresYearly state-level rates of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g).ResultsFrom January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers.Conclusions and RelevanceIn this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.

中文翻译：

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美国各州社会支出与早产和低出生体重


重要性在美国，不良出生结局，包括早产和低出生体重，与社会经济劣势密切相关，对黑人母亲的婴儿影响尤为严重。增加对社会项目的投资是解决出生结果差异的潜在政策方法。目的研究政府社会项目支出与总体早产率和种族低出生体重率的州级关联。设计、设置和参与者这项横断面生态学研究于 2011 年 1 月 1 日至 2019 年 12 月 31 日期间在美国 50 个州的活产婴儿中进行。数据分析于 2022 年 5 月至 2024 年 5 月进行。暴露每个低收入人群在以下类别的社会计划上的年度州和地方政府支出：州可退还的收入所得税抵免;现金援助;托儿援助;住房和社区发展;和公共卫生。主要结局和措施年度州级早产率（胎龄 <37 周）和低出生体重 （<2500 克）。结果从 2011 年 1 月 1 日至 2019 年 12 月 31 日，美国有 3510 万活产婴儿，其中 340 万例 （9.8%） 为早产儿，280 万例 （8.1%） 为低出生体重儿。每个低收入人群的州社会支出中位数 （IQR） 为 1546 美元（1074 美元至 2323 美元）。较高的国家社会总支出与较低的总体早产率相关（每低收入人群每增加 1000 美元，调整后的患病率 [aPR]，0.99;95% CI，0.97-0.999），但与总体低出生体重率无关。在二次分析中，较高的国家社会支出与黑人母亲婴儿的较低早产率相关 （aPR， 0.96;95% CI， 0.92-0.999）。国家支出增加，特别是现金援助（aPR，0.64;95% CI，0.43-0.94）和住房和社区发展（aPR，0.91;95% CI，0.84-0.98）与黑人母亲婴儿的早产率较低有关。结论和相关性在这项横断面生态学研究中，国家层面对社会计划的支出增加与早产率降低有关，尤其是对于黑人母亲的婴儿。州和地方政府可以考虑增加对现金援助以及住房和社区发展的投资，以解决孕产妇和婴儿健康差距。